Individual
JENNIFER MARIE SULT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1400 E 9TH ST, ROCHESTER, IN 46975-8931
(574) 223-2020
(574) 223-5847
Mailing address
1400 E 9TH ST, ROCHESTER, IN 46975-8931
(574) 223-2020
(574) 223-5847
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01062520A
IN
208D00000X
General Practice Physician
01062520A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200863600
—
IN
Enumeration date
04/18/2007
Last updated
10/02/2014
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